A Systematic Review on the Role of Robotic Microsurgery for Brachial Plexus Reconstruction

Abstract

Robotic microsurgery has revolutionized surgical practices, offering unprecedented precision and minimally invasive techniques. This article presents an updated overview of the role of robotic microsurgery in brachial plexus reconstruction. Robotic systems provide unique advantages, including high-resolution 3D visualization with magnification up to 40X, precise movements magnified up to 10X, ergonomic work conditions, and elimination of physiological tremors. While brachial plexus injuries pose significant surgical challenges, early diagnosis and treatment are crucial for optimal outcomes. Robotic-assisted procedures offer minimally invasive options, reducing morbidity and improving patient prognosis. A historical perspective traces the evolution of robotic surgery from its inception in the 1980s to the development of advanced systems like the da Vinci Surgical System and the Versius Surgical Robotic System. Notable milestones include the application of robotics in microsurgery, with successful arterial and venous anastomoses and nerve grafting procedures demonstrated in animal models and cadavers.  

Methods A systematic literature search was performed using appropriate search terms in databases to identify all applications of robotic assistance in brachial plexus surgery. Two authors reviewed all articles, and a qualitative synthesis was performed of those articles that met the inclusion criteria. The systematic review and results were conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines.

Results Seventeen studies met the inclusion criteria. These studies were reviewed, and the data were synthesized. Recent studies have explored robotic techniques for brachial plexus exploration and nerve reconstruction, showcasing promising outcomes in both experimental and clinical settings. Surgeons have successfully performed nerve repair procedures using robotic systems, overcoming challenges such as oversized instruments and lack of proprioceptive feedback.